Introduction. The conventional
Objective. In a cruciate retaining total knee arthroplasty (CR-TKA) for patients with flexion contracture, to ensure that an extension gap is of sufficient size to install an implant, the amount of distal femur
To compare the volume of acetabular
Aims. Sagittal plane imbalance (SPI), or asymmetry between extension and flexion gaps, is an important issue in total knee arthroplasty (TKA). The purpose of this study was to compare SPI between kinematic alignment (KA), mechanical alignment (MA), and functional alignment (FA) strategies. Methods. In 137 robotic-assisted TKAs, extension and flexion stressed gap laxities and
BACKGROUND. We conducted this study to determine if the pre-surgical patient specific instrumented planning based on Computed tomography scans can accurately predict each of the femoral and tibial resections. The technique helps in optimization of component positioning and hence overall alignment thereby reducing errors. This makes it less invasive, more efficient and cost effective. The surgical plan in combination with the cutting guides determine the resection thickness, component size, femoral rotation and femoral and tibial component alignment. Several clinical studies have shown that PSI is safe, accurate and reproducible in primary TKA. Accurate preparation of the femoral and tibial surfaces will determine alignment and component positioning and this in turn reflects on function and longevity. METHODS. The study was conducted prospectively between May 2016 and December 2017 in our institution. Patients admitted over a period of these twenty months were included in the study. Patients with primary or secondary osteoarthritis (OA) and inflammatory arthritis who were suitable to undergo patient-specific TKA were included in the study. Patients with conventional instrumented TKR and those with significant deformities requiring constrain including valgus or varus of greater than 20 degrees with incompetent lateral or medial collateral ligaments were excluded from the study along with revisions of partial knee to TKA using PSI blocks. Prophecy® Preoperative Navigation 3D printed Guides were used for the Evolution Medial Pivot knee replacement system (. Microport Orthopaedics (Arlington, TN 38002, USA)). in all cases. The operating surgeon measured all the resections made (4 femoral and 2 tibial) using vernier calipers intraoperatively. These measurements were then compared with the preoperative CT predicted
Introduction. Although, the total knee arthroplasty (TKA) procedure is performed to make the same extension gap (EG) and flexion gap (FG) of the knee, it is not clear how the gaps can be created equally. According to earlier reports, the gaps after
Distal femur resection for correction of flexion contractures in total knee arthroplasty (TKA) can lead to joint line elevation, abnormal knee kinematics and patellofemoral problems. The aim of this retrospective study was to establish the contribution of soft tissue releases and bony cuts in the change in maximum knee extension in TKA. Data were available for 209 navigated TKAs performed by a single surgeon using a medial approach. All patients had the same cemented implant, either CR or PS, which both required a minimum thickness of 10 mm for the tibial and 9mm for the femoral component. Intra-operatively pre- and post-implant extension angles and the size of
Purpose: Local resection with or without irradiation is the primary treatment modality of soft tissue sarcomas. Adequate surgical margin is required for local tumour control and avoiding local recurrence. Adjacent bone should be included into the resection plan if the tumour is in the close proximity of the bone or cortical and medullary tumour invasion was present. Reconstruction method depends on the location. Methods: 25 patient (10 female, 15 male) with soft tissue sarcomas received local wide excision including adjacent bone between 1995–2007. Histological types were 3 MPNSTM, 3MFH, 10 Synovial sarcoma, 2 liposarcoma, 4 angiosarcoma, 2 fibrosarcoma, 1 Leiomyosarcoma. Localisations were 5 glutea, 9 thigh, 5 cruris, 1 forearm, 5 foot. In 8 patients with proximal
Distal femur resection for correction of flexion contractures in total knee arthroplasty (TKA) can lead to joint line elevation, abnormal knee kinematics and patellofemoral problems. The aim of this retrospective study was to establish the contribution of soft tissue releases and bony cuts in the change in maximum knee extension in TKA. Data were available for 211 TKAs performed by a single surgeon using a medial approach. Intra-operatively pre- and post-implant extension angles and the size of
Purpose of the study: Assessment of limb reconstruction results using vascularized fibular grafts after bony resection for malignant tumors in children. Material and methods: Thirty children (9 girls and 21 boys)underwent surgery between 1993 and 2000. Mean age was 11 years. Tumor localizations were: femur (n=17), tibia (n=6), humerus (n=5), radius (n=1) and distal ulna (n=1). Mean length of
In this study, we aim to compare total bone amount extracted in total knee arthroplasty in implant design and the bone amount extracted through intercondylar femoral notch cut. In this study, we implemented 10 implants on a total of 50 sawbones from 5 different total knee arthroplasty implant brands namely Nex-Gen Legacy (Zimmer, Warsaw, IN, USA), Genesis 2 PS (Smith&Nephew, Memphis, TN, USA), Vanguard (Biomet Orthopedics Inc., Warsaw, IN, USA), Sigma PS (De Puy, Johnson&Johnson, Warsaw, IN, USA), Scorpio NRG PS (Stryker Co., Kalamazoo, USA). Equal or the closest sizes of each brand on anteroposterior plane were selected, and cuts were made following standard technique(see Fig 1 and 2). Extracted bone pieces were measured in terms of volume and length on three planes, and statistically analysed. The volume of all pieces available after each femoral incision was measured according to Archimedes’ principles. Furthermore, the volume of each intercondylar femoral notch pieces was measured separately from other pieces but with the same method. The measurement of intercondylar femoral notch pieces on 3 planes (medial-lateral, anterior-posterior, superior-inferior) was made using Kanon slide gauge (Ermak Ltd, Istanbul, TR). Femoral notch incision pieces were scanned with CAD/CAM technology using three-dimensional scanner 1 SeriesTM (Dental Wings Inc, Montreal, QC, Canada), and the measurements were confirmed with DWOS CAD 4.0.1 software (Dental Wings Inc, Montreal, QC, Canada)(see figure 3a-e). The volume of 10 intercondylar femoral notch pieces performed through the set of each brand was averaged, and considered as the incision volume of that particular brand.Objective
Material and Method
Introduction. Aneurysmal bone cysts commonly found in lower limbs are locally aggressive masses that can lead to bony erosion, instability and fractures. This has major implications in the lower limbs especially in paediatric patients, with potential growth disturbance and deformity. In this case series we describe radical aneurysmal
Introduction: The use of allograft prosthetic composite (APC) of the proximal tibia offers advantages over prosthetic replacement or osteoarticular graft with a better functional outcome since the possibility of a careful soft tissue reconstruction;. Materials and Methods: From 1994 to 2002, 62 APC of the proximal tibia were performed in our department after
Aims. Femoroacetabular impingement (FAI) patients report exacerbation of hip pain in deep flexion. However, the exact impingement location in deep flexion is unknown. The aim was to investigate impingement-free maximal flexion, impingement location, and if cam deformity causes hip impingement in flexion in FAI patients. Methods. A retrospective study involving 24 patients (37 hips) with FAI and femoral retroversion (femoral version (FV) < 5° per Murphy method) was performed. All patients were symptomatic (mean age 28 years (SD 9)) and had anterior hip/groin pain and a positive anterior impingement test. Cam- and pincer-type subgroups were analyzed. Patients were compared to an asymptomatic control group (26 hips). All patients underwent pelvic CT scans to generate personalized CT-based 3D models and validated software for patient-specific impingement simulation (equidistant method). Results. Mean impingement-free flexion of patients with mixed-type FAI (110° (SD 8°)) and patients with pincer-type FAI (112° (SD 8°)) was significantly (p < 0.001) lower compared to the control group (125° (SD 13°)). The frequency of extra-articular subspine impingement was significantly (p < 0.001) increased in patients with pincer-type FAI (57%) compared to cam-type FAI (22%) in 125° flexion. Bony impingement in maximal flexion was located anterior-inferior at femoral four and five o’clock position in patients with cam-type FAI (63% (10 of 16 hips) and 37% (6 of 10 hips)), and did not involve the cam deformity. The cam deformity did not cause impingement in maximal flexion. Conclusion. Femoral impingement in maximal flexion was located anterior-inferior distal to the cam deformity. This differs to previous studies, a finding which could be important for FAI patients in order to avoid exacerbation of hip pain in deep flexion (e.g. during squats) and for hip arthroscopy (hip-preservation surgery) for planning of
Introduction and Objective. TKA have shown both excellent long-term survival rate and symptoms and knee function improvement. Despite the good results, the literature reports dissatisfaction rates around 20%. This rate of dissatisfaction could be due to the overstuff that mechanically aligned prostheses could produce during the range of motion. Either size discrepancy between
INTRODUCTION. Mechanical alignment in TKA introduces significant anatomic modifications for many individuals, which may result in unequal medial-lateral or flexion-extension
Osteosarcoma and other types of bone cancers often require
In the last years, 3d printing has progressively grown and it has reached a solid role in clinical practice. The main applications brought by 3d printing in orthopedic surgery are: preoperative planning, custom-made surgical guides, custom-made im- plants, surgical simulation, and bioprinting. The replica of the patient's anatomy, starting from the elaboration of medical volumetric images (CT, MRI, etc.), allows a progressive extremization of treatment personalization that could be tailored for every single patient. In complex cases, the generation of a 3d model of the patient's anatomy allows the surgeons to better understand the case — they can almost “touch the anatomy” —, to perform a more ac- curate preoperative planning and, in some cases, to perform device positioning before going to the surgical room (i.e. joint arthroplasty). 3d printing is also commonly used to produce surgical cutting guides, these guides are positioned intraoperatively on given landmarks to guide the surgeon to perform a specific surgical act (bone osteotomy,